Search Results (9)

Incentive spirometry is widely used in respiratory rehabilitation to enhance lung expansion and prevent postoperative pulmonary complications. However, conventional devices, including volume-oriented and flow-oriented incentive spirometers, rely on subjective visual interpretation, which may limit measurement accuracy and clinical utility. A digital incentive spirometer (DIS) has been developed to provide objective, real-time measurements of inspiratory volume. This study aimed to evaluate the agreement and reliability between the DIS and a volume-oriented incentive spirometer (VIS) across different age groups. A cross-sectional study was conducted in 150 participants aged 7–80 years, stratified into five age groups with equal sex distribution. Inspiratory volume was measured simultaneously using both devices. Agreement was assessed using Bland–Altman analysis, and reliability was evaluated using intraclass correlation coefficients (ICC). The DIS demonstrated good overall reliability (ICC = 0.868, 95% CI: 0.821–0.903). The mean difference was 48.69 mL, indicating slight overestimation by the DIS. However, the limits of agreement were wide (−469.24 to 566.63 mL), suggesting limited interchangeability. Reliability varied across age groups, with the highest ICC in older adults and the lowest in adolescents. The DIS showed good reliability but limited agreement with the VIS. Full article

Background: Inspiratory training using an incentive spirometer (IS) improves respiratory symptoms and functional status in Long COVID. In Taiwan, NRICM101 is commonly used during the acute phase; however, its impact on rehabilitation outcomes remains unclear. Objective: This study evaluated the effects of IS-based respiratory training and the potential influence of prior NRICM101 use. Methods: Participants were grouped by time since recovery, and pre-post changes after six weeks of IS training were compared between those with and without self-reported prior NRICM101 use. Primary outcomes were dyspnea and functional status; secondary outcomes included six-minute walk distance and arterial oxygen content. Results: IS training significantly improved dyspnea (p < 0.0001), functional status (p < 0.0001), and exercise endurance (NRICM101 group: p = 0.002; no NRICM101 group: p < 0.0001). Stratified analysis showed that when initiated within three months of recovery, participants without prior NRICM101 use had greater improvements in dyspnea (p < 0.0001), functional status (p = 0.001), and exercise endurance (p < 0.0001). Conclusions: Prior NRICM101 use may be associated with different rehabilitation patterns, likely reflecting differences in recovery trajectory or patient behavior rather than purely pharmacological effects. Full article

Background/Objectives: COVID-19 and its sequelae have affected millions worldwide, with many individuals experiencing persistent symptoms such as dyspnea, fatigue and reduced quality of life. Respiratory physiotherapy is commonly used to support patients with pulmonary conditions. This systematic review aimed to evaluate the effects of the incentive spirometer on cardiopulmonary, functional and patient-reported outcomes in adults during the acute and post-COVID-19 phases. Methods: A systematic literature search was conducted in PubMed, CINAHL, Scopus, Clinical Trials.gov and Google Scholar to identify studies published between January 2020 and April 2025. Owing to substantial heterogeneity in study design, populations, interventions and outcome measures, quantitative synthesis was not feasible and findings were synthesized narratively. Results: Twelve studies involving 573 participants were included. Within-group analyses showed improvements in pulmonary outcomes (including FEV₁, FVC, and oxygen saturation), reductions in dyspnea, and improvements in quality of life following incentive spirometer. Improvements in pulmonary function were reported primarily in post-COVID-19 populations, whereas reductions in anxiety and improvements in quality of life were reported mainly in acute COVID-19 settings. Between-group comparisons demonstrated statistically significant differences in favor of the incentive spirometer for selected pulmonary and functional outcomes (including FVC, DLCO, oxygen saturation, six-minute walk test, and 30 s sit-to-stand test), while no significant differences were observed for other outcomes such as peak expiratory flow, respiratory rate, or heart rate variability. Randomized controlled trials were judged to have a moderate risk of bias, non-randomized studies a moderate-to-serious risk, and certainty of evidence ranged from very low to moderate. Conclusions: Incentive spirometer may support respiratory, functional, and psychological recovery in adults during the acute and post-COVID-19 phases. However, effects vary across outcomes and comparator interventions, and the overall certainty of evidence is low to moderate. Further high-quality research is required to confirm effectiveness and guide optimal clinical use. Full article

Background/Objectives: This study presents an artificial intelligence (AI)-supported incentive spirometry system designed to explore the feasibility of automating the monitoring of respiratory exercises, a critical nursing intervention for maintaining pulmonary function and reducing postoperative complications. Methods: This system uses a tablet’s camera to track a standard spirometer’s volume indicator in real-time, reducing the manual nursing workload, unlike traditional mechanical spirometers that lack feedback capabilities. Image processing techniques analyze exercise performance, while the interface provides instant feedback, data recording, and graphical display. Machine learning models (Random Forest, XGBoost, Gradient Boosting, SVM, Logistic Regression, KNN) were trained on scripted patient data, including demographics, smoking status, and spirometry measurements, to classify respiratory performance as “poor”, “good”, or “excellent”. Results: The ensemble methods demonstrated exceptional performance, achieving 100% accuracy and R² = 1.0, with cross-validation mean accuracies exceeding 99.4%. This feasibility study demonstrates the technical viability of this AI-driven approach and lays the groundwork for future clinical validation. Conclusions: This system presents a potential cost-effective, accessible solution suitable for both clinical and home settings, potentially integrating into standard respiratory care protocols. This system not only reduces nursing workload but also has the potential to improve patient adherence. This pilot study demonstrates the technical feasibility and potential of this AI-driven approach, laying the groundwork for future clinical validation. Full article

Background: To report the evaluation of incentive spirometry (IS)-induced pressure changes in intra-abdominal drainage catheters and consider its use for maintaining catheter patency and enhancing drainage. Methods: Prospective study of patients with indwelling intra-abdominal drainage catheters for abdominal fluid collections who had their intra-abdominal pressures measured while performing incentive spirometry. Patients were instructed in the use of an incentive spirometer. Within a week after initial drainage, pressure changes with IS were evaluated three times at 1500 cc and three times at maximum inspiratory effort. Intra-abdominal pressure (IAP) was measured using a pressure monitor connected to the drainage catheter. Results: Twenty patients (men, 12; women, 8). Fluid collection locations were pelvis, Right-upper quadrant (RUQ), Left-upper quadrant (LUQ), Left-lower quadrant (LLQ), and Right-lower quadrant (RLQ). A total of 16 of 20 patients showed an elevation of IAP with IS. At 1500 cc, the pressure increased by an average of 41.24 mmH₂O. At maximal inspiratory effort, the pressure increased by an average of 48.26 mmH₂O. Pressure increase was greater in upper abdomen catheters. Four patients with lower abdominal and pelvic collections showed minimal pressure changes with IS. Conclusion: IS increases IAP and fluid flow through abdominal drainage catheters. Future studies are warranted to determine whether the use of IS enhances catheter performance and facilitates drainage via its effect on IAP. Full article

Ultrasound guided parasternal block is a regional anaesthesia technique targeting the anterior branches of intercostal nerves, which supply the anterior thoracic wall. The aim of this prospective study is to assess the efficacy of parasternal block to manage postoperative analgesia and reduce opioid consumption in patients undergoing cardiac surgery throughout sternotomy. A total of 126 consecutive patients were allocated to two different groups, receiving (Parasternal group) or not (Control group) preoperative ultrasound guided bilateral parasternal block with 20 mL of 0.5% ropivacaine per side. The following data were recorded: postoperative pain expressed by a 0–10 numeric rating scale (NRS), intraoperative fentanyl consumption, postoperative morphine consumption, time to extubation and perioperative pulmonary performance at incentive spirometry. Postoperative NRS was not significantly different between Parasternal and Control groups with a median (IQR) of 2 (0–4.5) vs. 3 (0–6) upon awakening (p = 0.07); 0 (0–3) vs. 2 (0–4) at 6 h (p = 0.46); 0 (0–2) vs. 0 (0–2) at 12 h (p = 0.57). Postoperative morphine consumption was similar among groups. However, intraoperative fentanyl consumption was significantly lower in the Parasternal group [406.3 ± 81.6 mcg vs. 864.3 ± 154.4, (p < 0.001)]. Parasternal group showed shorter times to extubation [(191 ± 58 min vs. 305 ± 72 min, (p)] and better performance at incentive spirometer with a median (IQR) of 2 raised balls (1–2) vs. 1 (1–2) after awakening (p = 0.04). Ultrasound guided parasternal block provided an optimal perioperative analgesia with a significant reduction in intraoperative opioid consumption, time to extubation and a better postoperative performance at spirometry when compared to the Control group. Full article

Introduction: To address the problem of incentive spirometry (IS) noncompliance, a use-tracking IS reminder device (SpiroTimer™) was developed. In a recent randomized clinical trial, the SpiroTimer™ improved IS use compliance, length of stay, and mortality. For successful, safe, and effective implementation of a new medical device, human factors and usability must be evaluated. This study aims to evaluate the SpiroTimer™’s human factors as they pertain to intended users, use environments, and uses. Material and methods: Immediately following the completion of the randomized clinical trial of the SpiroTimer™, before the providers were informed of the results of the study, a human factors and usability survey was distributed in-person to all nurses involved in the trial. Variations in nurse user perspectives were evaluated. Results: A total of 52 nurses (100% response rate) completed the survey. In general, most nurses felt IS use compliance is poor (65%; 34/52, p = 0.0265) and should be improved (94%; 49/52, p < 0.001). Nurses agreed the SpiroTimer™ ameliorated patient IS use compliance (82%; 41/50, p < 0.001), IS effectiveness (74 %; 37/50, p < 0.001), and patient engagement in their own care (88%; 44/ 50, p < 0.001). Nurses reported the SpiroTimer™ helped remind them to work with their patients on IS (70%; 35/50, p = 0.0047) while reducing the number of times they had to remind their patients to use their IS (70%; 35/50, p = 0.0047). They felt that they would use the SpiroTimer™ with all their patients (82%; 41/50, p < 0.001) and that they would recommend the SpiroTimer™ to a colleague (74%; 37/50, p < 0.001). Ultimately, most nurses believed the SpiroTimer™ should become part of routine patient care (78%; 39/50, p < 0.001). Discussion: For a new medical technology to a medical device to be effectively implemented, human factors and usability must be demonstrated. Nurses believe the clinically effective SpiroTimer™ helps both patients and nurses and should become part of routine care. Full article

(1) Background: Oncological gastrectomy requires complex multidisciplinary management. Clinical pathways (CPs) can potentially facilitate this task, but evidence related to their use in managing oncological gastrectomy is limited. This study evaluated the effect of a CP for oncological gastrectomy on process and outcome quality. (2) Methods: Consecutive patients undergoing oncological gastrectomy before (n = 64) or after (n = 62) the introduction of a CP were evaluated. Assessed parameters included catheter and drain management, postoperative mobilization, resumption of diet and length of stay. Morbidity, mortality, reoperation and readmission rates were used as indicators of outcome quality. (3) Results: Enteral nutrition was initiated significantly earlier after CP implementation (5.0 vs. 7.0 days, p < 0.0001). Readmission was more frequent before CP implementation (7.8% vs. 0.0%, p = 0.05). Incentive spirometer usage increased following CP implementation (100% vs. 90.6%, p = 0.11). Mortality, morbidity and reoperation rates remained unchanged. (4) Conclusions: After implementation of an oncological gastrectomy CP, process quality improved, while indicators of outcome quality such as mortality and reoperation rates remained unchanged. CPs are a promising tool to standardize perioperative care for oncological gastrectomy. Full article

A smartphone-based tidal volume (V_T) estimator was recently introduced by our research group, where an Android application provides a chest movement signal whose peak-to-peak amplitude is highly correlated with reference V_T measured by a spirometer. We found a Normalized Root Mean Squared Error (NRMSE) of 14.998% ± 5.171% (mean ± SD) when the smartphone measures were calibrated using spirometer data. However, the availability of a spirometer device for calibration is not realistic outside clinical or research environments. In order to be used by the general population on a daily basis, a simple calibration procedure not relying on specialized devices is required. In this study, we propose taking advantage of the linear correlation between smartphone measurements and V_T to obtain a calibration model using information computed while the subject breathes through a commercially-available incentive spirometer (IS). Experiments were performed on twelve (N = 12) healthy subjects. In addition to corroborating findings from our previous study using a spirometer for calibration, we found that the calibration procedure using an IS resulted in a fixed bias of −0.051 L and a RMSE of 0.189 ± 0.074 L corresponding to 18.559% ± 6.579% when normalized. Although it has a small underestimation and slightly increased error, the proposed calibration procedure using an IS has the advantages of being simple, fast, and affordable. This study supports the feasibility of developing a portable smartphone-based breathing status monitor that provides information about breathing depth, in addition to the more commonly estimated respiratory rate, on a daily basis. Full article